Fluid build up in the legs, also known as edema, is a common condition that occurs when excess fluid gets trapped in the lower extremities. This can make the legs appear swollen or puffy, and in severe cases can cause the skin to stretch and become shiny. There are a few key things to look for when trying to identify fluid build up in the legs:
Swelling
One of the most noticeable signs of fluid build up is swelling or enlarged legs and ankles. This occurs as excess fluid accumulates under the skin, causing the tissue to expand. Often swelling is first noticeable in the feet and ankles toward the end of the day when fluid has had more time to accumulate due to the effects of gravity. The swelling may create a visible dent when pressure is applied, a sign known as pitting edema.
Skin changes
As more fluid builds up, it can cause the skin over the legs to become stretched and take on a shiny or taut appearance. The skin may also feel cool or damp to the touch. In some cases the skin may become so tight that it shows the outline of the bones and tendons underneath.
Weight gain
Fluid retention can cause sudden or rapid weight gain, particularly in the lower body. Stepping on the scale may reveal extra pounds seemingly overnight. This is generally not true fat gain but simply extra water weight being held in the tissue.
Discomfort or tightness
Excess fluid in the legs can make them feel heavy, stiff or achy. Clothes and shoes may feel tighter than usual. There may also be a feeling of tightness or skin indentation when pressing on the area. In severe untreated cases, fluid build up can compress nerves and cause leg pain.
Changes in leg shape
Fluid build up often causes the shape of the legs to appear abnormal or distorted. The calves or ankles may look swollen and disproportionately large compared to the thighs. Extra fluid in the thighs and knees can cause a bowed or splayed leg appearance.
What causes fluid retention in the legs?
There are a number of potential causes for fluid building up and pooling in the lower legs. Some of the most common include:
Medications
Some medications, such as corticosteroids, NSAIDs, calcium channel blockers, and estrogen can interfere with fluid balance and lead to retention. Chemotherapy drugs may also cause leg swelling.
Pregnancy
Hormonal changes during pregnancy often result in extra fluid accumulation. This is especially common during the third trimester and typically resolves after delivery.
Kidney disease
Chronic kidney disease or failure can allow fluid levels to build up and overload the blood and tissue. The kidneys play an important role in filtering excess fluid.
Liver disease
When the liver is damaged or diseased, it impairs the production of albumin, an important protein in maintaining fluid in the bloodstream rather than the tissue. Low albumin allows liquid to leak out into the legs.
Heart failure
A weak heart has difficulty pumping blood efficiently. This results in blood and fluid backing up, particularly in the lungs, legs and feet. Leg swelling is often one of the first signs of heart failure.
Venous insufficiency
Faulty valves inside the veins of the legs normally prevent backflow of blood. If the valves are damaged, blood can leak back into the veins and pool in the legs. This is known as venous insufficiency.
Lymphedema
When lymph nodes are blocked or removed, it can interfere with proper lymph drainage from the legs and cause a buildup of protein-rich fluid. This commonly occurs after cancer procedures.
Blood clots
A blood clot in the deep veins of the legs, known as deep vein thrombosis, prevents proper blood circulation and can lead to increased pressure and fluid build up.
Dependency or inactivity
Remaining immobile or inactive for long periods can cause fluid accumulation in the calves and feet. This is due to the lack of muscle contractions which normally help pump fluid back to the heart.
Risk factors
Certain medical conditions and lifestyle factors may increase risk for fluid retention in the legs. These include:
– Older age – the veins and circulation tend to become less efficient with aging
– Obesity – excess body weight strains the heart and blood vessels
– Varicose veins – twisted enlarged veins that allow blood to pool in the legs
– Inactivity or sedentary lifestyle
– Pregnancy – increased fluid volume and pressure from the uterus
– Medications like birth control, steroids, and NSAIDs
– Poor diet high in salt or processed foods
– Underlying kidney, liver, or heart disease
– Past surgery or radiation therapy on the legs or pelvis – can damage the lymphatic system
Complications
Fluid buildup that continues unchecked can worsen over time and lead to a number of complications:
Skin infection
Prolonged fluid buildup stretches the skin and can cause weeping sores or cracks to develop. These create openings for bacteria to enter and potentially cause cellulitis infection.
Leg ulcerations
As fluid exerts greater pressure, it can cause tissues to break down and form painful open sores or ulcers on the lower legs.
Skin discoloration
Congested blood and fluids just under the surface may cause dusky red or purple skin tones. The ankle area often develops a browned or discolored appearance.
Difficulty walking or decreased mobility
Swellollen stiff legs and compressed nerves can make walking difficult or painful. Moving the ankle may also become difficult.
Deep vein thrombosis
Buildup of blood and fluid in the veins can cause them to enlarge and blood to coagulate. This forms a clot known as deep vein thrombosis which poses risk of pulmonary embolism.
When to see a doctor
It’s important to consult a physician for any unexplained or abnormal leg swelling that persists more than a few days, or is accompanied by other symptoms. Seek urgent medical care if you experience:
– Rapid severe swelling over hours or days
– Skin that feels very tight or painful
– Difficulty walking or leg pain
– Skin that is red, hot and tender
– Fever, chills or overall illness
– Shortness of breath or chest pain
– Calf pain, tenderness, warmth or redness that may indicate blood clot
Quick medical attention is needed to reduce risk of complications like infection or blood clots traveling to the lungs. Sudden or unilateral leg swelling can be a sign of blood clot or other serious medical issues.
Diagnosis
To determine the exact cause of fluid build up, the doctor will perform a physical exam of the legs and ask about any associated symptoms. They may use a finger to apply pressure and check for pitting edema. Tests may include:
Blood tests
These check for signs of kidney disease, liver disease or infection. Blood counts also help rule out clotting problems.
Urinalysis
A urine sample can show if excess fluid is due to kidney abnormalities. Protein in the urine can indicate kidney damage allowing leakage.
Imaging tests
An ultrasound uses sound waves to look for blockages or blood clots in the veins. An MRI can check soft tissues for abnormalities. Chest x-ray looks for fluid buildup in or around the lungs.
Echocardiogram
This test uses sound waves to visualize the heart structure and pumping function. It helps determine if heart failure is a contributing cause.
Lymphoscintigraphy
A radioactive tracer is injected to track lymph drainage in the legs. This helps diagnose lymphedema.
Treatment
Treatments focus on reducing swelling, managing underlying conditions, and preventing recurrence of fluid build up.
Diuretics
Medications like furosemide (Lasix) help the kidneys excrete more sodium and water from the blood. This reduces fluid volume and pressure.
Compression stockings
These elastic stockings provide graded pressure up the leg. This helps push fluid back into circulation and prevent pooling.
Leg elevation
Keeping the legs raised above the heart several times a day utilizes gravity to improve drainage and reduce swelling.
Lymphatic massage
Specialized massage techniques encourage flow in the lymphatic system to improve drainage. This helps treat lymphedema.
Water pills
Diuretics or water pills make you urinate out more fluid from the bloodstream. Common options are triamterene or spironolactone.
Exercise
Low impact exercise like walking, swimming, or cycling can help pump fluid out of the legs. But avoid straining swollen legs.
Compression pumps
These devices use inflatable sleeves to improve venous and lymphatic drainage from the limbs. Helpful for home use.
Salt reduction
Limiting dietary sodium avoids fluid retention. Salty foods like canned soup, pizza, and processed meats are common culprits.
Here is a table summarizing the key points:
| Signs of Fluid in Legs | Causes | Risk Factors | Complications | Diagnostic Tests | Treatments |
|---|---|---|---|---|---|
| Swelling in ankles or feet | Medications, pregnancy, kidney disease, heart failure | Older age, obesity, varicose veins, pregnancy | Skin infections, leg ulcers, decreased mobility | Blood tests, urinalysis, ultrasound, x-rays | Diuretics, compression stockings, leg elevation |
| Skin appears shiny and tight | Liver disease, DVT, venous insufficiency | Inactivity, hormone medications, poor diet | Skin discoloration, DVT, pulmonary embolism | MRI, echocardiogram, lymphoscintigraphy | Lymphatic massage, water pills, exercise |
| Noticeable weight gain | Lymphedema, blood clots, dependency | Surgery/radiation, underlying diseases | Leg ulcers, difficulty walking | Compression pumps, salt reduction |
Prevention
Steps to help prevent fluid from accumulating in the legs include:
– Maintaining a healthy body weight
– Exercising regularly to improve circulation
– Avoiding sitting or standing still for long periods
– Managing any underlying medical conditions
– Taking medications as prescribed
– Avoiding constrictive clothing around thighs and knees
– Elevating legs periodically throughout the day
– Wearing compression stockings if at risk
– Reducing salt and processed foods in diet
– Staying hydrated by drinking water
Outlook
Mild fluid retention will often resolve with some simple self-care measures like rest, elevation, and monitoring for worsening symptoms. Medical treatment is aimed at relieving symptoms and reducing the risk of complications.
Prognosis depends on the underlying cause and disorder leading to fluid build up. Kidney disease, chronic venous insufficiency, lymphedema and recurrent leg swelling can become chronic conditions requiring long-term treatment.
Catching it early and controlling risk factors are important to prevent permanent skin damage, leg wounds, and loss of function. With proper adherence to preventive strategies and prescribed treatment, fluid accumulation in the legs can often be well managed.
Conclusion
Fluid retention in the legs appears as swelling, weight gain, skin tightness and discomfort. It is most commonly caused by issues with the heart, kidneys, veins or lymphatic system. Complications like infection and blood clots can occur if severe edema is left untreated. Tests like bloodwork, imaging and urinalysis help diagnose the cause. Treatments aim to improve drainage and reduce recurrence. Prevention through diet, exercise, leg elevation and compression stockings is key, especially for those at increased risk due to obesity, medication use or inactivity. While chronic fluid build up can be challenging to treat, close monitoring and both medical and at-home care can effectively reduce symptoms and improve quality of life.